DRC EBOLA SITUATION REPORT 25 December 2018

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Total funding

available*85%

Funding Gap15%

Ebola Response Funding Status 2018

Ebola NK and Ituri Phases I & II

Funding requirements* :

$ 25,763,204

* Funding requirement includes budget for phase I ($ 8,798,899), phase II ($ 13,031,305) and phase II.I ($ 3,933,000) **Funds available include Reprogrammed funds from Equateur Response

UNICEF’s Response

Target Result

# of at-risk people reached through community engagement

and interpersonal communication approaches. (door-to-

door, church meetings, small-group training sessions, school

classes, briefings with leaders and journalists, other)

11,500,000

8,205,269

# of listed eligible people for ring vaccination informed of

the benefits of the vaccine and convinced to receive the

vaccine within required protocols.

54,028† 53,031

# of people with access to safe water in the affected health

zones 2,060,758 1,202,812

# of teachers briefed on Ebola prevention information 32,296 6,555

# of affected families with confirmed, suspects, probable

cases who received one or several kits of assistance to

support their children

659* 659

† The target is dynamic as listing of eligible persons is defined

*The target is estimated based on both the number of confirmed, probable and suspected case, and is adjusted according to the

response

SITUATION IN NUMBERS 25 December 2018

Democratic Republic of the Congo

Ebola Situation Report North Kivu and Ituri

585 total reported cases (MoH, 25 December 2018)

537 confirmed cases (MoH, 25December 2018)

308 deaths recorded among

confirmed cases (MoH, 25 December 2018)

7,428 contacts under surveillance (MoH, 25 December 2018)

UNICEF Ebola Response

Appeal

US$ 25.763M

Highlights • The Strategic Response Plan (SRP) was reviewed by the Ministry of

Health, leading to SRP 2.1 which covers the period up to 31 January

2019. Following this, the total budget required for the overall Ebola

response in North Kivu and Ituri provinces for August 2018 to January

2019 is now estimated at USD 128.6 million, up from SRP 2’s USD 105

million.

• As part of the joint SRP 2.1, UNICEF’s budget requirement is now

estimated at USD 25.7 million, an increase from USD 21.8 million in SRP

2. At present, UNICEF’s response has a funding shortfall of USD 3.9

million.

• The elections were postponed from 23 December to 30 December, with

the National Election Commission further declaring that there will be no

elections in Beni and Butembo in December due to the epidemic and

instability. This has brought about pockets of civil unrest in affected

areas, and the negative impact on the response is already being felt.

Photo Credit: Guy Hubbard

DRC EBOLA SITUATION REPORT 25 December 2018

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Epidemiological Overview1Summary Table (25.12.18):

Province Health Zone Confirmed and Probable Cases Total deaths

recorded among

confirmed cases

Suspect Cases under

investigation Confirmed Probable Total

Nord-Kivu

Beni 211 9 220 123 36

Butembo 39 0 39 27 11

Kalanguta 37 12 49 17 5

Kyondo 6 2 8 3 2

Mabalako 85 16 101 50 6

Masereka 7 1 8 2 0

Musienene 4 1 5 2 2

Mutwanga 3 0 3 2 0

Oicha 13 0 13 4 0

Katwa 77 4 81 47 10

Vuhovi 8 0 8 3 0

Biena 1 0 1 0 0

Ituri Mandima 17 3 20 10 2

Komanda 27 0 27 16 0

Tchomia 2 0 2 2 0

TOTAL 537 48 585 308 74

Previous Total 10 December 2018 452 48 500 240 87

1 Data source: Epidemiological table based on daily CNC numbers

DRC EBOLA SITUATION REPORT 25 December 2018

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Key epidemiological developments

Key points in the evolution of the epidemic during the reporting period include a notable increase in confirmed cases

reported in Oicha, Komanda, and Mabalako health zones, following a period with very minimal or no confirmed cases.

In Komanda health zone, ramping up the response here has become a top priority. In Mangina, in Mabalako health zone,

UNICEF is working with partners for the implementation of two mobile teams made up of WASH and communications

staff to be rapidly deployed in locations with confirmed cases, working with communities and local actors to quickly

scale-up control and prevention activities in the affected areas.

Beni, Butembo, Katwa, and Kalanguta health zones are also areas of concern for the epidemic due to the high number

of reported confirmed and probable cases. This situation presents a high risk of the epidemic’s further spread to Goma

due to high daily mobility from Butembo, particularly through the axe Butembo – Lubero – Goma. Although the epidemic

seems to have stabilized in Beni, the risks still exist as surrounding geographical areas remain affected.

Humanitarian leadership and coordination

The Crisis Management Team continued to meet daily under the leadership of the Ministry of Health with all concerned

partners and with the chairs of the different working groups providing thematic updates. UNICEF continues to support

coordination in all locations with functional strategic or operational commissions, and co-leads the commissions on

communication, WASH, and psychosocial care. UNICEF is also active in the working groups on logistics and vaccination.

A UNICEF security specialist is also deployed in the field to support security assessment and safety of the operations.

A recent development that is expected to have an important impact on the coordination and implementation of the

response is the postponement of the elections, scheduled for 23 December 2018, to 30 December 2018. The National

Election Commission further declared that there will be no elections in Beni and Butembo until March 2019, due to the

epidemic and instability. This has brought about pockets of civil unrest in affected areas, and the negative impact of this

development on the response is already being felt.

At the moment, UNICEF activities in risk communication and prevention, WASH, and psychosocial care are focused

around five coordination hubs based in Beni, Butembo, Tchomia, and Mabalako health zones. One sub-coordination hub

is operational in Bunia city.

The coordination of UNICEF’s response is dynamic due to the identification of confirmed cases and the geographical

extension of the epidemic to newly affected health zones. UNICEF coordinates Musienene, Katwa, Masereka, Vuhovi,

Kalanguta, and Kyondo’s response from the sub-coordination group based in Butembo health zone, and efforts are

underway for a second coordination team to be based in Butembo. A UNICEF multi sectorial team was deployed on

December 5th to respond to the extension of the outbreak in Komanda.

Response Strategy

In support of the joint response plan, the UNICEF response strategy will continue to focus on communication, WASH,

and psychosocial care, nutrition, and a cross-cutting education sector response. As the epidemic continues into its fifth

month, an operational review of the response led by the Ministry of Health is currently being carried out. The Ebola

strategic response plan (SRP)was reviewed jointly by the MoH, WHO, UNICEF, and partners, leading to the development

of SRP 2.1. The main goals of this revision include broadening the geographic scope of the response by deploying teams

in geographic rings ahead of the virus, as follows: full response teams in health zones with confirmed cases at present;

active response (mobile teams) in regions with contacts or within population movement routes leading to or out of zones

with active cases; and stand-by teams in peripheral regions within eastern DRC for preparedness activities. Beyond

January 2019, a longer-term perspective of a six-month response up to June 2019 is also being discussed.

• Risk communication, social mobilization and community engagement with the aim to (1) proactively engage with

affected and at-risk communities, (2) provide timely and accurate health advice to encourage positive health seeking

DRC EBOLA SITUATION REPORT 25 December 2018

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behaviors, and (3) address community concerns and rumors. The strategy is implemented through 5 pillars that

include (i) community engagement; (ii) promotion of preventive behaviors; (iii) responding to resistance; (iv) advocacy

and capacity building of actors and (v) communication in support of ring vaccination, surveillance, safe and dignified

burials, and Ebola treatment centers

• The WASH strategy, as part of the Infection Prevention and Control (IPC), aims to stop the spread of the disease

through the availability of (1) WASH in public and private health care facilities, as well as reinforcement of basic WASH

services and awareness with traditional practitioners, which includes providing water and WASH kits, (2) hygiene

promotion and the provision of WASH kits in schools, including handwashing stations and soap/temperature check

points, (3) WASH in communities through mass outreach on hygiene promotion to vulnerable communities and the

setup of handwashing stations/temperature control in strategic transit locations, and (4) joint supervision of health

infrastructures to ensure quality and efficient sustainability of programs are developed

• The child protection and psychosocial support to EVD confirmed and suspect cases and their family members as well

as contact families seek to (1) provide psychosocial support, (2) establish or re-establish social and community

networks and support systems, (3) provide social kits to EVD-affected families, and (4) identify and provide

appropriate care to orphans and unaccompanied children due to the Ebola epidemic. The key elements of the strategy

include (i) psychosocial support for EVD confirmed and suspect cases, including children; in the Ebola treatment

centers (ETC), psychosocial activities for children and their families, (ii) material assistance to affected families to

better support children, (iii) the facilitation of professional help for children and families with more severe

psychological or social problems/needs, (iv) the coordination of mental health and psychosocial support (MHPSS),

and (vi) psychosocial assistance, appropriate care, and research of long-term solutions for orphans and

unaccompanied children.

• The nutrition component will provide the appropriate nutritional care for EVD patients including children. The

nutrition component will also promote and protect infant and young child feeding practices in the EVD context, in

both the ETCs and in communities, with a special focus on orphans, separated, and other vulnerable infants and young

children such as children with lactating mothers with a high risk of contact, or lactating mothers identified as frontline

health workers, among others. The early detection of acute malnutrition cases and the adequate management of

severe acute malnutrition in the affected health zones will also be supported. UNICEF will support the government in

strengthening the coordination of the nutrition response through the cluster coordination mechanisms.

• The education sector strategy involves key EVD prevention measures on the school premises, including: (1) mapping

of schools to identify its proximity with a confirmed case and the identification of schools in the affected health areas,

(2) training of educational actors (students, teachers, inspectors, school administration agents, head of educational

provinces, parents’ association) on Ebola prevention in schools including WASH in school, psychosocial support in

classrooms, and against discrimination, (3) provision of infrared thermometers and handwashing kits in schools

including clean water, soap, and capacity reinforcement on hygiene behaviors, (4) provision of school cabins for school

entry checking, (5) provision of specific documentation and protocol for prevention, guidance, and management of

suspected cases in school, (6) provision of key messages on Ebola prevention to families, and (7) close monitoring of

the effective use and implementation of the protocol of prevention of EVD in schools

DRC EBOLA SITUATION REPORT 25 December 2018

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Summary Analysis of Programme Response

An overview of the key elements in the response, with a special emphasis on UNICEF’s response in the affected health

zones, is detailed below.

Communication and social mobilization (C4D)

Community Engagement

C4D teams in Beni, Mangina, Butembo, Bunia, and Komanda health zones have continued their efforts to strengthen

community engagement and community-based surveillance of the epidemic. The teams are now supported by ten

additional UNICEF C4D Officers in Komanda and in newly affected health zones around Butembo, namely Katwa,

Masereka, Lubero, Kyondo, Vuhovi and Kalunguta. A C4D Manager, based in Butembo, leads the coordination of C4D

interventions.

In Komanda, with the support of UNICEF and its partner, Caritas, 167 community leaders were actively involved in

mobilizing their communities’ efforts to curb the epidemic. Community dialogue sessions are conducted in villages in

and around the epidemic’s epicenter. For example, the chief of Wales Vonkutu, a chiefdom located near Komanda,

mobilized all 18 village and community leaders who were then briefed by UNICEF’s C4D Officer on the risks of Ebola

disease and preventive measures. Community actors engaged in community mobilization activities are identified using

a participatory “village” approach, where community influencers and social mobilizers are chosen by members of the

village, with the participation of the village chief. The Caritas Bunia team regularly ensures monitoring missions to the

health areas.

To further strengthen community engagement, community platforms that have already been implemented in the

neighborhoods of Beni health zone were reorganized according to the health areas, conforming to the DRC’s health

system. Various youth groups are now engaged in Butembo health zone to participate actively in the Ebola response.

With the support of Caritas, at least 110 representatives and leaders of the youth groups of Butembo evaluated progress

in the levels of awareness and engagement of young people. These groups also put in place measures to improve the

impact of their interventions.

Responding to Resistance and Rumors

A study on knowledge, attitudes, and practices (KAP), using both quantitative and qualitative methodologies, was

conducted in the Komanda health zone on 20 to 24 December 2018, with UNICEF support. The study aims to determine

the level of knowledge, attitudes, and practices of the population following four weeks of the Ebola response in the zone,

and analyze community perceptions. The information collected will enable the fine-tuning of the C4D strategy to meet

the specific needs of the response in the zone. A total of 19 villages were randomly selected in eight health areas,

including four EVD-affected health areas and four unaffected health areas. Four-hundred household heads were

interviewed.

The survey results show that due to the outbreak, the community no longer perceives the hospital as an environment

that can give them hope of recovery. Given this, some care structures are reporting only five patients per day seeking

services, compared with more than 50 patients a day before the epidemic. The community members interviewed say

they are afraid to go to the health center because they might be identified as a suspected Ebola case. Others believe

that health workers "report suspected cases that are then brought to Beni to die". The indigenous peoples of Komanda

health zone, who represent about 30% of the zone’s population, consider EVD as a "Bantu people disease", or a disease

of the people who are not indigenous to the area.

To avoid the frustration of patients, prevent resistance, and address the community’s fears, the investigation team

recommends that the Ebola treatment center (ETC) and laboratory be made functional in Komanda as soon as possible.

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The recommendations also state that the response team must strengthen their relationship with the leaders of the

indigenous populations of Komanda, involving them as mediators and in community engagement efforts.

The KAP survey also highlighted low awareness in the health zone on the importance of safe and dignified burials (SDB).

Only 21% of respondents in the affected areas know that SDB are organized to prevent the spread of the epidemic, not

significantly higher than in the non-affected health areas at 19%. Regarding the Ebola vaccine, 76% of those interviewed

in the affected health areas are aware of its existence, compared to only 42% in the unaffected health areas.

Resistance in Komanda health zone was found to be mainly related to rumors about the vaccine and safe SDB. A

vaccination team was attacked two weeks ago in a village of Komanda by the indigenous people.

To better manage this situation, UNICEF and its partners have supported the organization of a traditional ceremony in

Idowu health area, with the participation of all the elders of the village, indigenous peoples, and other groups.

Commitments were made by indigenous peoples, village leaders, and other influential community members to accept

response teams and engage in the fight against EVD. In other health areas, communication teams doubled up efforts to

coordinate with authorities of the villages where incidents of resistance have been reported. Teams also supported the

organization of community dialogue sessions. The C4D UNICEF team made two visits to the villages on the Bwanasura –

Kazaroho axis, where strong reluctance was noted. Awareness-raising sessions and dialogues are continuing in these

villages to facilitate immunization and decontamination activities.

Despite extensive efforts carried out by C4D teams, incidents of rumors, reluctance, and resistance were noted during

the reporting period in the other health zones. For example, in Mangina health zone, the primary reason for resistance

is the community’s belief that “the Ebola epidemic is already over", negatively affecting the level of community

engagement in the response.

In Beni health zone, neighborhood leaders accompany the teams of the different commissions to manage resistance,

and a positive impact in most neighborhoods has been observed. In Rwangoma health area, the youth gathered to

address resistance, with more than 15 community leaders visiting the ETC to familiarize themselves with procedures in

this structure so that they can educate members of their communities. Reinforced efforts continue to be made in more

challenging neighborhoods that express stronger resistance towards the response.

Promotion of Preventive Behaviors

To strengthen community awareness of preventive behaviors, over 3,800 factsheets with information on Ebola in Swahili

and in French, were disseminated in the affected areas of North Kivu and Ituri provinces. This tool was developed by the

National Communication Commission with the support of UNICEF, and includes the contributions and feedback of field

teams.

In Komanda health zone, after the capacity-building of various actors, sensitization on preventive behaviors continued

through door-to-door visits, religious leaders in churches and mosques, community leaders, and mass media. According

to the KAP study, these activities reached at least 85% of the population in all health areas included in the survey, with

this percentage reaching 93% in affected health areas compared to 76% in the non-affected health areas. The survey also

found that community-based workers and churches were the main sources of information for the population in the

affected health areas, with 63% and 44% of the respondents identifying them as their main information source,

respectively.

Despite the high percentage of the population receiving information, the KAP study shows that knowledge levels on

preventive practices remain low. Only 54% of respondents in the affected health areas know at least three methods of

EVD prevention. This number is much lower in non-affected health areas, with only 33%. This highlights the need to

further strengthen communication interventions on preventive behaviors. For example, through mobilizing more

DRC EBOLA SITUATION REPORT 25 December 2018

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influencers including village and neighborhoods chiefs, youth and women leaders, and local social networks such as

churches, women's and youth associations. Interactive programs in local radios will also be multiplied.

C4D Preparedness

To prepare surrounding provinces for the possible spread of EVD to their areas, reinforced efforts were made to prepare

local leaders and communities in vulnerable zones for a potential response. In Kisangani, opinion leaders and pastoral

workers were trained by Caritas in communication approaches and essential messages for Ebola prevention. Trained

youth groups are also taking action to raise awareness for several target audiences. In addition, at least four local radio

stations are engaged in Kisangani and Isangi to educate people about the risks of Ebola disease and prevention measures.

Water, Hygiene and Sanitation (WASH)

During the reporting period, the health zone of Komanda in nearby Ituri province continued to report EVD cases. The

health zone has now reported a total of 27 confirmed cases. To quickly address the emerging needs, UNICEF WASH

specialists have been deployed and directly support the Ministry of Health (MOH) to provide 20 health facilities in

affected areas with handwashing stations and infection prevention and control (IPC) materials. During distributions,

training is provided by WHO and medical NGOs on IPC, triage, case detection, and referrals.

Forty schools and 103 public places in locations close to confirmed cases were also provided with handwashing stations.

In addition, UNICEF providing all the WASH facilities to contribute to the set-up of a local Emergency Operations Center

(EOC). UNICEF WASH has signed a small-scale funding agreement with the local NGO MUSAKA to scale-up activities in

affected communities around Komanda. Discussions are ongoing with other potential partners to work along the road

between Komanda and Bunia, and accelerate the IPC work in health facilities in the area.

As a consequence of the increase in cases in Komanda health zone, the road between Bunia and Beni has become a

hotspot with several locations affected: Nyakunde between Komanda and Bunia, and Otomaber and Oicha between

Komanda and Beni. UNICEF WASH, together with the education teams, are planning to work with local partners to

increase prevention activities in schools surrounding the location of confirmed cases. Churches and public places will

also be targeted. However, some of the locations are challenging to reach; for example, Oicha is difficult to access due

to insecurity.

As new cases continue to be identified

in Butembo and Katwa health zones every day, UNICEF WASH supported the prevention commission in adjusting the

response strategy by improving the monitoring of activities done for each case, particularly in the surroundings of the

homes of the confirmed cases, considering the short-cycle transmission mode of the disease and the worrying low

proportion of known contacts among the last confirmed cases (20%, according MOH/World Health Organization). Key

activities to be done around the location of each confirmed case include decontamination, the distribution of household

prevention kits, distribution in schools of handwashing and cleaning/disinfecting kits with briefing sessions for the

teachers and students, and the distribution of handwashing kits to public areas such as churches, markets, and moto taxi

parking lots with public awareness sessions.

The performance-based payment system in Beni health zone is ongoing for 72 health facilities. The number of facilities

decreased from the previous Situation Report after eight facilities were dropped out of the performance-based financing

program following evaluations showing ineligibility. After the distribution of IPC kits to the facilities during the reporting

period, a first post-distribution evaluation will be conducted this week to measure the progress made by each facility.

UNICEF WASH and the Research Unit is planning to conduct a formative research study in mid-January with the staff of

a sample of targeted health facilities to better understand their perception of the project, its acceptance and level of

implementation, and the Ebola response as a whole. This study will be conducted together with WHO.

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Key activities in the reporting period

• In Komanda, 20 health facilities in the four most affected health areas were provided with handwashing stations in

clinical areas and near toilets; 236 health staff were trained in IPC; and 40 schools benefitted from a WASH

intervention. In addition, UNICEF is directly supervising the building of eight toilets and four showers for the local

EOC. UNICEF is also overseeing the installation of a ten-cubic meter water storage unit and is looking for prospective

areas for a borehole to be drilled soon.

• In Butembo, 14 health facilities were equipped with toilets and showers; 107 handwashing stations were distributed;

20 health facilities received a complete IPC kit; 68 handwashing stations were distributed to 13 schools; and one

orphanage was supported with the construction of two toilets and two showers. In addition, the WASH team is

contributing to building toilets at the coordination center in Butembo and is supporting the construction of the

nursery at the ETC.

• In Beni, two public water taps with water storage are 90% completed and are already delivering drinking water to

the population nearby the hospital and Ebola transit center. Ten of the biggest churches in the city were equipped

with handwashing stations prior to the Christmas gathering, and four orphanages are being supported to improve

sanitary conditions.

Education

Over the past two weeks, 13 new EVD cases, including 11 confirmed, were reported in 11 primary and secondary schools

in Butembo, Mabalako, and Komanda health zones, impacting school attendance negatively. The number of schools with

confirmed cases represents an increase of more than five times from the last Situation Report, with only two schools.

Specific interventions are being implemented focusing on schools with confirmed cases. Seven of the 11 schools with

confirmed cases are located in Butembo health zone. Of these seven schools, five benefitted from sensitization activities

to ensure that the EVD prevention protocol is well implemented. Four schools were decontaminated, with all students

also receiving vaccinations. Sensitization activities were also conducted in the three affected schools in Mabalako health

zone and in the one affected school in Komanda health zone. The process of decontamination and vaccination is ongoing

for these schools, as well as for the remaining three schools in Butembo health zone. Six additional schools in Beni health

zone also benefitted from sensitization activities. It was observed that students as well as teachers and school directors

are becoming more conscious and aware of the danger of EVD. They are therefore accordingly applying the prevention

protocol.

To address this worrying development, UNICEF and its partners scaled up activities and were able to reach 20,089

children and 151 members of Parents’ Committees in Beni, Butembo, Komanda, and Bunia health zones with information

on EVD prevention and on prevention measures taken specifically in the schools. The number of children reached

represents a 19% increase from the results of the last reporting period. As reported in the WASH section of the Situation

Report, UNICEF WASH teams and their partners also provided handwashing facilities and thermoflashes2 to several

schools in the affected health zones.

Since the beginning of the response, a total of 125,694 children in 645 schools have been reached out of the over one

million children targeted by the response, 12% of the target. Ebola prevention information for schools using the Guidance

Note for EVD Prevention in Schools, and posters and banners with Ebola prevention messages were provided to 1,678

teachers and heads of schools, including 24 heads of non-formal education institutions who were reached in

collaboration with UNESCO.

To enable the scaling up of the implementation of the EVD protocol in schools, in line with the new targets of the

response, 25 master trainers made up of inspectors and school directors were trained on the Guidance Note for EVD

2 Non-contact thermometers

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Prevention in Schools. In addition, the two provincial ministries of education were actively involved in all school

activities. They recommended all school directors to give daily briefings on EVD prevention to all students and teachers

before the beginning of classes to achieve "Zero Ebola in Schools". They also required the inspectors to monitor the use

of the handwashing kits and thermoflashes during their school visits.

Psychosocial and Child Protection3

Key results

• During the reporting period, 112 children admitted to ETCs and received individual psychological assistance. Of this

number, 48 were confirmed EVD cases while 64 were suspected cases. This number is more than two times the

number of children admitted to ETCs in the last Situation report. This can be attributed to the increase in areas

affected by EVD and in more cases being alerted in the areas. With these results, UNICEF has reached a total of 635

children in the ETCs and the nurseries children since the beginning of the response4.

• On Christmas Day, UNICEF supported holiday celebrations for 44 children and their care workers in the EVD

treatment centers and the nurseries.

• One-hundred fifty-six families newly affected by EVD, including both confirmed and suspected cases, received

psychosocial support and/or material assistance in all the affected health zones of North Kivu and Ituri Provinces.

The assistance provided includes 125 hygiene kits and 385 food assistance packs distributed to discharged and cured

patients. Eighteen families also received funeral kits, while 59 families received NFI kits5.

• 92 children, including 44 orphans and 48 separated children, were identified. These children have been orphaned or

separated due to the Ebola epidemic. A total of 497 orphans or separated children have been identified since the

start of the response. They were all provided with appropriate care, including NFI kits and food assistance. The

number of orphans and separated children identified during this reporting period represents an increase of 22%

from the last Situation Report. As with the number of children passing through ETCs, this increase is attributed to

the increase areas affected by EVD as well as the increase in cases.

• 1,365 contact persons received a psycho-social support in the EVD-affected health zones of North Kivu and Ituri

provinces reaching a total of 7,428 persons.

Other activities and needs/gaps identified

• Two contact families who were identified as high risk were located en route to Goma from Beni after having been in

Kisangani. They are being supported in their return to Beni.

• Forty-eight psychosocial assistants and nine psychologists were trained in case management and how to deal with

community resistance, specifically relating to challenging contexts in Katwa following increased community reticence

in recent weeks. In all affected areas, teams of psychosocial assistants and psychologists continue to work face-to-

face daily with community members to deal with resistance and reticence.

• In Bwanasura/Komanda in Ituri province, 75 new psychosocial agents were trained to meet the additional needs for

psychosocial assistance linked to the increase of Ebola cases.

• Following the situation in Komanda health zone, with the increasing number of confirmed cases, 687 contacts in

Komanda and 181 contacts in Nyankunde received psychosocial support and food assistance. In addition, a joint

psychoeducation activity was organized by the psychosocial and communication commissions for 13 traditional

healers and 349 persons.

3 The UNICEF Child Protection team in DRC co-leads the psycho-\social pillar of the Ebola response with the Ministry of Health. The implementing partners are Danish Refugee Council (DRC) for North Kivu and Caritas for Ituri. All results, unless otherwise stated, are UNICEF results with implementing partners. 4This figure is issued from data collected by the psychosocial commission. 5 Non-food items provided under the response’s psychosocial component are customized according to the specific needs of the target beneficiaries. Items can include mattresses, sheets, kitchen utensils, baby items, etc.

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Nutrition

For the reporting period, 277 patients in ETCs received adequate nutritional care. Of this number, 29 were infants less

than six months old, including 18 newborns.

In the communities and at the household level, the nutritionists and psychosocial agents supported by UNICEF provided

adequate feeding care to 29 infants less than six months old. They also sensitized 1,229 women caregivers on adequate

infant and young child feeding practices (IYCF) in the Ebola context.

Following efforts to monitor the use of breastmilk substitutes (BMS), the 29 infants at the community-level, including 18

newborns, were identified as being unable to breastfeed. These infants, from Ebola-affected zones, are in orphanages or

separated from their mothers, while some are being treated in the ETCs together with their mothers who are too weak

to nurse. Others are infants of frontline health workers, at high risk of contact and needing vaccination. The infants are

reported to have received BMS, highlighting the crucial need to promote and protect IYCF practices. A new strategy for

supporting IYCF in the community needs to be put in place, in coordination with the psychosocial commission.

PRONANUT, the national nutrition program, has requested UNICEF to procure RUIF (ready to use infant formula), to be

used as a last resort for infants unable to breastfeed. The first quantities will arrive by 10 January 2019 in the country. As

needs are expected to be high, new orders need to be placed.

In addition to the above, the following activities were carried out by the UNICEF nutrition staff during the reporting

period:

• New UNICEF nutrition staff were deployed in Beni.

• An informative sheet on IYCF in the Ebola context and the use of BMS was developed by staff and the nutrition

cluster, targeting other response actors and donors.

• A meeting with implementing partners, Alima, Médecins Sans Frontières, and the Danish Refugee Council, was held

to advocate for the strict application of the guidelines on limiting the use of BMS and the code of marketing of

breastmilk substitutes.

• Specific information sheets on cup-feeding was developed, targeted to health workers in ETCs. Cup-feeding is an

alternative to using bottles and teats, that is in compliance with IYCF guidelines.

• The supervision of nutritional activities in the ETCs and the supply of 2,600 cartons of ready-to-use therapeutic food

(RUTF) and essential medicines for the treatment of severe acute malnutrition cases in the affected health zone are

ongoing.

Supply & Logistics

Since the beginning of the response, USD 3,355,266.97 worth of items composed of WASH, C4D, child protection, health,

education, and ICT supplies have been procured for the Ebola response in Ituri and North Kivu provinces. Offshore

procurement represents a total value of USD 1,310,256.71 or 39 %, and local procurement represents a total value of

USD 2,044,993.26 or 63%.

Human Resources

As of 23 December, 81 UNICEF staff members are deployed to the affected health zones in North Kivu and Ituri provinces.

In preparation for a scenario where the epidemic persists and/or intensifies, efforts are underway to increase UNICEF’s

surge capacity.

External Communication

The CO issued a new press release focused on the number of Ebola-cases among children, linked to the visit of UNICEF’s

Regional Director for West and Central Africa to the affected zone. The press release was picked-up widely by

international media, including by Mail Online UK, CGTN News, ABC.es, All Africa.com, Europa Press, Deutsche welle,

Channelafrica.co.za, ENCA, New York Times, Itv.com, Prensa Latina and Mail Online UK. The CO also facilitated a press

DRC EBOLA SITUATION REPORT 25 December 2018

11

mission to the affected region for ITV, NRC Handelsblad/NOS, De Volkskrant, and Frankfurter Randschau. A videographer

for UNICEF travelled during the reporting period to Beni and Butembo, gathering photo and video material that are being

posted on WeShare and are accessible to all.

The UNICEF CO published 53 articles on its blog since the beginning of the crisis, as well as 52 Facebook posts, 33 pictures

on Instagram, and almost 350 tweets. Recent stories posted on digital platforms include Ebola: inform to better vaccinate

and Getting back to normal after Ebola strikes.

Funding

On 20 December 2018, following the strategic and operational review of the response conducted in Beni and Butembo

from 8-10 December, the MOH updated the Ebola Response Plan (Strategic Response Plan 2.1, November 2018 – January

2019) to include assumptions and additional needs until 31 January 2019. The needs therein are estimated at USD

23,506,000.00. With this, the grand total of the budget for the Ebola response in North Kivu and Ituri provinces from

August 2018 to January 2019, including the initial budget and the additional budget needed, is now estimated

at USD 128,617,545.

As part of the joint response plan, UNICEF’s response strategy focusing on communication, WASH, psychosocial care,

nutrition, and a cross-cutting education sector response is estimated at USD 25.7 million. At present, UNICEF’s response

has a funding shortfall of USD 3.9 million.

Next Sitrep: 06 January 2019

Funds available

Funds Received

Current Year**$ %

Water, Hygiene and Sanitation - WASH / IPC 12,320,519 10,136,819 2,183,700 18%

Communication for Development (C4D) -

Community engagement and

Communication for Campaigns

6,841,005 5,963,389 877,616 13%

Child protection and Psychosocial Support 2,251,200 1,854,000 397,200 18%

Medical Care : Management of Severe Acute

Malnutrition in Ebola Treatment Center749,800 750,800 0 0%

Operations support, Security and

Coordination costs and Information and

Communications Technology

3,278,680 2,856,585 422,094 13%

Prepardness Plan 322,000 300,000 22,000 7%

Total 25,763,204 21,861,593 3,902,610 15%

Funding gap

Funding Requirements

(as defined in the UNICEF component of the Joint Ebola Response plan and aligned to the UNICEF Humanitarian Appeal 2018)

* Funding requirement includes budget for phase I ($ 8,798,899), phase II ($ 13,031,305) and phase II.I ($ 3,933,000)

** Funds available include reprogrammed funds from Equateur Response

Appeal SectorRequirements*

$

Who to contact for further information:

Pierre Bry Chief Field Operations UNICEF DRC Tel: + (243) 817 045 473 E-mail: pbry@unicef.org

Gianfranco Rotigliano Representative a.i. UNICEF DRC Tel: + (243) 996 050 399 E-mail: grotigliano@unicef.org

Tajudeen Oyewale Deputy Representative UNICEF DRC Tel : +(243) 996 050 200 E-mail : toyewale@unicef.org

DRC EBOLA SITUATION REPORT 25 December 2018

12

Ebola Response Tracking Indicators (10 Dec 2018)

Nord Kivu Province 2018

New

Target

Total

results

Change since

last report

▲▼

RESPONSE COORDINATION

# of affected localities with functioning partner coordination mechanism 6 6 0

COMMUNICATION FOR DEVELOPMENT

# of members of influential leaders and groups reached through advocacy, community

engagement and interpersonal communication activities. (CAC, religious /traditional

leaders, opinion leaders, educators, motorists, military, journalists, indigenous group leaders,

special populations, and adolescents.

15,500 14,360 1,551

#of frontline workers (RECO) in affected zones mobilized on Ebola response and

participatory community engagement approaches. 10,200 8,644 712

# of at-risk population reached through community engagement, advocacy, interpersonal

communications, public animations, radio, door-to-door, church meetings, schools,

adolescent groups, administrative employees, armed forces.

11,500,000 8,205,269 652,692

# of households for which personalized house visits was undertaken to address serious

misperception about Ebola, refusals to secure burials or resistance to vaccination. 900 889 55

# of listed eligible people for ring vaccination informed of the benefits of the vaccine and

convinced to receive the vaccine within required protocols. 54,028† 53,031 8,584

% of respondents who know at least 3 ways to prevent Ebola infection in the affected

communities (from Rapid KAP studies)** 80% 91% 0

WATER, SANITATION & HYGIENE

# of health facilities in affected health zones provided with essential WASH services. 857+ 506 49

# of target schools in high risk areas provided with handwashing facilities 2,476+ 565 88

# of community sites (port, market places, local restaurant, churches) with hand washing

facilities in the affected areas 1,848+ 1052 104

# of people with access to safe water source in the affected areas 2,060,758+ 1,202,812 95,000

EDUCATION

# of students reached with Ebola prevention information in schools 1,090,006 125,694 20,089

# of teachers briefed on Ebola prevention information in schools 32,296 6,555 1,678

CHILD PROTECTION AND PSYCHOSOCIAL SUPPORT

# of affected families with confirmed, suspects, probable cases who received one or several

kits of assistance to support their children 659* 659 79

# of affected families, including children, with confirmed, suspects and probable cases who

received continuous psycho-social support in their community 659* 659 79

# of contact family members, including children, who receive psycho-social support and/or

material assistance 8128** 7428 1107

# of separated children and orphans identified who received appropriate care and psycho-

social support 600 501 92

NUTRITION

# of < 23 months children caregivers who received appropriate counseling on IYCF in

emergency 9,756 4,786 1,229

† The target is dynamic as the listing of eligible persons evolves +The target changes with shifts in the epidemiology

* This target is estimated based on the number of confirmed, probable, and suspected cases, and is adjusted as the response progresses. ** The target is dynamic and 100% of listed contacts is the identified target